CASE MANAGEMENT GUIDEBOOK: Supporting …

CASE MANAGEMENT GUIDEBOOK:

Supporting Households Moving

Out of Homelessness

SPONSORED BY:

The State of Florida Department of Economic Opportunity

PRESENTED BY:

The Florida Housing Coalition June 2018

FOREWORD

Welcome to this guidebook on case management to help households move out of homelessness and remain stably housed. We know how hard you work - whether you are a nonprofit or local government leader, or a case manager working in outreach, shelter, rapid rehousing, permanent supportive housing, or community-based services.

The intent of this guidebook is to guide, encourage, and highlight best practices for case managers working specifically with households experiencing homelessness. While there are numerous resources on case management in a generalist setting, homelessness presents unique challenges and issues. The Florida Housing Coalition offers this information to serve as a framework for case managers working in homeless service settings to provide effective services to help households quickly exit homelessness, obtain and maintain stable housing, and never return to homelessness.

To complement this guidebook, we offer a seven-part Case Management Webinar Series, which is available on our website at . The guidebook and webinar series taken together offer a great resource to orient new hires, reenergize current case managers, and strengthen every organization embracing best practices and quality improvement.

If you have stories to share, or additional suggestions or questions, contact us at the Florida Housing Coalition. We are here to help you help our neighbors.

Table of Contents

ESSENTIAL PRINCIPLES ...................................................................................................2

Trauma Informed Housing Focused Recovery Oriented Person Centered Strengths Based

CASE MANAGEMENT: COMPONENTS AND STANDARDS.....................................................6

Engagement Assessment Documentation Case Planning

THE HOUSING CRISIS RESPONSE SYSTEM.........................................................................19

Outreach Coordinated Entry Prevention and Diversion Emergency Shelter Rapid Re-Housing Permanent Supportive Housing

A TRAUMA-INFORMED APPROACH..................................................................................23

Understanding Trauma Responding to Trauma Implementation

TROUBLESHOOTING DIFFICULT CASES............................................................................26

Motivational Interviewing Use of Self

SELF-CARE....................................................................................................................30

APPENDICES................................................................................................................31

Appendix A Progress Note Examples Appendix B Action Plan Examples Appendix C Staffing Form Example Appendix D Sample Documentation Policies and Procedures Appendix E Resources

Essential Principles

Before we get into specific guidance, let's begin with the essential philosophy and principles underlying this guidebook.

Research, data, and best practice support the fact that stable housing is the key to helping a household end their episode of homelessness and reintegrate into the broader community.1 Therefore, the primary measures of success for case management and programs are measures of stable housing and connections to opportunity (e.g., employment, socialization, services).

Thus, the overarching framework is housing first. While the term "housing first" has been used in many different contexts, the housing first philosophy is at its core the recognition that people need housing first to end homelessness. Then, once housed in their own rental, and only as needed and desired, services are provided to help address any barriers to maintaining stable housing.

In the past, homeless service providers operated in a "services first" model requiring anything from sobriety to employment to receive services and, eventually, housing placement. These requirements and barriers created by provider agencies resulted in slow exits to housing, long lengths of stay in temporary or transitional shelter, and a backlog of people "stuck" in the crisis system. This outdated model often resulted in households with the more complex barriers remaining homeless for months or years, while becoming even less likely to engage in a homeless system that did not meet their needs.

The United States Interagency Council on Homelessness (USICH) recognizes that housing first is about changing the "DNA" of how the system responds to homelessness.2 In keeping with Opening Doors, the federal strategic plan to prevent and end homelessness, 3 every program work-

ing with households experiencing homelessness should be working to make homelessness rare, brief, and nonrecurring. The best way to accomplish this goal is for every community to implement housing first system-wide.

This guidebook, therefore, reflects housing first principles, recognizing that stable housing ends homelessness. The housing first philosophy helps us as case managers better define our role and duties. Now each time we take an action we ask ourselves, "Is this activity helping this household obtain or maintain stable housing?" Housing first also helps case managers narrow their focus to the housing stability needs of the household in front us, rather than feeling responsible for solving complex social problems such as poverty, low wage jobs, childhood trauma, and more.

Next, moving forward with the housing first framework, let's discuss some guiding principles for case management.

1. Trauma Informed 2. Housing Focused 3. Recovery Oriented 4. Person Centered 5. Strengths Based

Trauma Informed A trauma-informed approach is critical not only to the homeless services system, but also in our work with an individual household. The trauma-informed perspective recognizes that individuals experiencing homelessness have a higher prevalence of trauma histories; 4 therefore, our services must recognize trauma symptoms and respond in a way that is both sensitive and appropriate.

A trauma-informed approach replaces the question and mental perspective of "What is wrong with you?" to "What happened to you?"

1 2 3 4 SAMHSA ? SHIFT Study, available at:

2 THE FLORIDA HOUSING COALITION | WWW.

Trauma symptoms might show up in many ways ? mental health differences, substance use disorders, traumatic brain injuries, or generally "difficult behavior." Our ability to recognize these issues as symptoms of trauma, rather than "resistance" or "noncompliance," greatly changes how we provide services. A trauma-informed approach guides everything from organizational policies and procedures to how we greet someone at the front door. Later in this guidebook, we delve more deeply into the topics of trauma and implementing a trauma-informed approach.

Housing Focused As discussed above, stable housing is always the number one goal when providing services to households experiencing homelessness. All services should be housing focused in every type of program addressing homelessness ? emergency shelter, rapid rehousing, permanent supportive housing, or outreach.

Homeless service providers have the responsibility to help the client household exit homelessness and remain

stably housed. Activities not focused on quick placement into housing will distract from this primary responsibility.

If clients need services beyond assistance identifying and moving into permanent housing, then they should be connected to the community agency providing those services. For example, if a household requests mental health or primary care, they should be referred to the appropriate provider. The resources within the homeless service delivery system should always be directed toward housing and services supporting stable housing.

Recovery Oriented People in recovery are active agents of change in their lives; they are not passive recipients of services. 5 For the purposes of this guidebook, recovery is not limited to substance misuse. People can be in recovery from many different types of challenges, including physical health problems, mental illness, substance use disorders, trauma, and any combination of the above.

5 "Guiding Principles and Elements of Recovery-Oriented Systems of Care", SAMHSA, 2009, available at: product/Guiding-Principles-and-Elements-of-Recovery-Oriented-Systems-of-Care/SMA09-4439

FIGURE 1

12 Principles to Implement a Recovery-Oriented System of Care

1. There are many pathways to recovery 2. Recovery is self-directed and empowering 3. Recovery involves a personal recognition of the need for change and transformation 4. Recovery is holistic 5. Recovery has cultural dimensions 6. Recovery exists on a continuum of improved health and wellness. 7. Recovery emerges from hope and gratitude 8. Recovery involves a process of healing and self-redefinition 9. Recovery involves addressing discrimination and transcending shame and stigma 10. Recovery is supported by peers and allies 11. Recovery involves (re)joining and (re)building a life in the community 12. Recovery is a reality

CASE MANAGEMENT GUIDEBOOK | SUPPORTING HOUSEHOLDS MOVING OUT OF HOMELESSNESS 3

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